1 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Chapter 23 Extracorporeal Life Support

2 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Extracorporeal Support  The technique of supporting the function of the heart or lungs, or both, with external artificial organs

3 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. History  Gibbon  1937 animals  1953 humans  Lillehei 1955  Clowes 1956  Doren 1969  Barlett & Harken 1975

4 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Neonatal Treatment  Persistent pulmonary hypertension of the newborn  Meconium aspiration syndrome  Sepsis  Congenital diaphragmatic hernia

5 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Patient Selection  Oxygen index  Intraventricular hemorrhage  Gestation age  Coagulopathy  Pulmonary disease  Cardiac defects

6 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Pediatric Treatment  Research  European ECLS experience  O’Rourke  Weber  Swaniker

7 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Venoarterial Route

8 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Venovenous Route

9 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. ECLS Circuit

10 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Membrane Oxygenator

11 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Cannulation  Consent  Blood products  Patient positioning  Monitor patient and prepare equipment  Cannula insertion technique  Connect patient to circuit

12 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Management and Monitoring  Cardiovascular  Anticoagulation  Hematologic  Neurologic  Pulmonary  Fluid balance

13 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Weaning  Venoarterial  Improved lung function Decrease ECLS support; increase ventilator support Decrease ECLS support; increase ventilator support Intermittent clamp ECLS support Intermittent clamp ECLS support  Venovenous  Increase ventilator support  Isolate gas ports from ambient air

14 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Decannulation  Sedative and paralytic  Infusions to peripheral IVs  DC heparin  Mirror image of cannulation process

15 Elsevier items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Complications  Patient  Neurologic  Cardiac stun  Technical